Severe obesity and diabetes self-care attitudes, behaviours and burden: implications for weight management from a matched case-controlled study. Results from Diabetes MILES-Australia

• Published in: Diabetic medicine Vol. 31; no. 2; pp. 232 - 240
• Main Authors: Dixon, J. B., Browne, J. L., Mosely, K. G., Rice, T. L., Jones, K. M., Pouwer, F., Speight, J.
• Format: Journal Article
• Language: English
• Published: Oxford Blackwell Publishing Ltd 01.02.2014; Blackwell; Wiley Subscription Services, Inc
• Subjects: Adult; Aged; Attitude to Health; Attitudes; Australia - epidemiology; Behavior; Biological and medical sciences; Case-Control Studies; Cost of Illness; Diabetes; Diabetes Mellitus, Type 2 - complications; Diabetes Mellitus, Type 2 - epidemiology; Diabetes Mellitus, Type 2 - psychology; Diabetes Mellitus, Type 2 - therapy; Diabetes. Impaired glucose tolerance; Endocrine pancreas. Apud cells (diseases); Endocrinopathies; Etiopathogenesis. Screening. Investigations. Target tissue resistance; Feeding. Feeding behavior; Female; Fundamental and applied biological sciences. Psychology; Humans; Male; Medical sciences; Middle Aged; Obesity; Obesity, Morbid - complications; Obesity, Morbid - epidemiology; Obesity, Morbid - psychology; Obesity, Morbid - therapy; Perception; Self Care; Vertebrates: anatomy and physiology, studies on body, several organs or systems; Vertebrates: endocrinology; Weight control; Weight Reduction Programs - statistics & numerical data; Australia; Oceania; Endocrinopathy; Obesity; Nutrition; Attitude; Diabetes mellitus; Body weight; Nutrition disorder; Weight loss; Metabolic diseases; Corporal biometry; Result; Case study; Selfcare; Behavior; Severe; Endocrinology; Nutritional status
• ISSN: 0742-3071; 1464-5491; 1464-5491
• DOI: 10.1111/dme.12306

Aims To investigate whether diabetes self‐care attitudes, behaviours and perceived burden, particularly related to weight management, diet and physical activity, differ between adults with Type 2 diabetes who are severely obese and matched non‐severely obese control subjects. Methods The 1795 respondents to the Diabetes MILES—Australia national survey had Type 2 diabetes and reported height and weight data, enabling BMI calculation: 530 (30%) were severely obese (BMI ≥ 35 kg/m2; median BMI = 41.6 kg/m2) and these were matched with 530 control subjects (BMI < 35 kg/m2; median BMI = 28.2 kg/m2). Diabetes self‐care behaviours, attitudes and burden were measured with the Diabetes Self‐Care Inventory—Revised. Within‐group and between‐group trends were examined. Results The group with BMI ≥ 35 kg/m2 was less likely to achieve healthy diet and exercise targets, placed less importance on diet and exercise recommendations, and found the burden of diet and exercise recommendations to be greater than the group with BMI < 35 kg/m2. The group with BMI ≥ 35 kg/m2 was more likely to be actively trying to lose weight, but found weight control a greater burden. These issues accentuated with increasing obesity and were greatest in those with BMI > 45 kg/m2. There were no between‐group differences in other aspects of diabetes self‐care: self‐monitoring of blood glucose, use of medications and smoking. Moderate‐to‐severe symptoms of depression were independently associated with reduced likelihood of healthy diet and physical activity, and with greater burden associated with diet, physical activity and weight management. Conclusions Severely obese people with diabetes demonstrated self‐care attitudes, behaviours and burdens that infer barriers to weight loss. However, other important diabetes self‐care behaviours are supported equally by severely obese and non‐severely obese individuals. What's new? This analysis demonstrates, for the first time, that severely obese and non‐severely obese (BMI < 35 kg/m2) individuals with Type 2 diabetes differ in their perceptions of diet, physical activity and weight management. Despite more actively trying to lose weight, severely obese individuals placed less importance in, and report greater burden with, diet and exercise recommendations. These differences appear weight‐specific and not seen in other diabetes self‐care behaviours, including blood glucose monitoring or medication use. Awareness of this additional burden and specific support for weight management is clearly needed to improve diabetes self‐care outcomes for severely obese individuals.